Vol 98, No 1 (2017)

Theoretical and clinical medicine
Comparative analysis of physical development parameters of children with stages 1 to 3 of chronic kidney disease
Nastausheva T.L., Zhdanova O.A., Nastausheva N.S., Stahurlova L.I., Grebennikova I.V.

Aim. To conduct comparative analysis of height, weight and body mass index in children with stages 1 to 3 of chronic kidney disease (CKD) caused by recurrent urinary tract infection due to congenital anomalies of kidney and urinary tract.

Methods. The study was performed on 210 children: 110 patients examined in 2001-2002 (group 1) and 100 children examined in 2011-2012 (group 2). Stage 1 of CKD was observed in 94 (85.4%) children in group 1 and in 93 (93%) in group 2, stage 2 - in 16 (14.6%) and 7 (7%) patients, respectively. From both groups patients matched by sex, age, diagnosis and social status were selected: 20 patients with stage 1, 19 children with stage 2; in addition, 6 children with stage 3 were examined.

Results. Nowadays children with CKD stage 1 are taller compared to patients of the beginning of the XXI century (Z-score: -0.14±1.43 and 0.20±0.98 respectively, p=0.01). Significant differences in weight were found in children with stage 1 in 2011-2012 compared to the patients in 2001-2002 (0.18±0.46 and 0.78±1.19 for groups 1 and 2, respectively, р=0.026). A tendency towards decrease of average height in children with stage 3 is observed compared to patients with stage 1, i.e. due to the progression of the disease.

Conclusion. The data obtained reflect modern tendencies towards increase of children height and weight. No significant differences were found in physical development parameters of children with stages of chronic kidney disease 1 and 2 examined at the same time period but a tendency towards children’s height decrease from stages 1 to 3 of CKD of non-glomerular etiology was revealed.

Kazan medical journal. 2017;98(1):5-9
Drug correction of functional constipation in children
Bulatov V.P., Ziganshina A.A., Kamalova A.A., Nizamova R.A.

Aim. To conduct a comparative analysis of the effectiveness of lactulose and lactitol for the treatment of chronic constipation in children.

Methods. 30 patients of the diagnostic unit of Children’s republican clinical hospital, Kazan, were randomly divided into 2 groups of 15 children matched by gender and age. Patients from group 1 were prescribed lactulose as a baseline therapy, and patients from group 2 were prescribed lactitol according to their age dose from day 1 of hospital stay with the assessment of the effectiveness on day 10 at discharge. Statistical processing of the results of research was conducted with the use of the program Biostatistica (S.A. Glantz, McGraw Hill) and spreadsheet editor Microsoft Excel 2003. The reliability of the data was calculated by methods of variation statistics. To compare performance when receiving lactulose and lactitol, paired Student’s t-test was used in case of normal distribution and Wilcoxon test was applied in case of skewed distribution. Pearson criterion was used to evaluate the correlation in case of normal distribution of the compared variables, and calculation of Spearman’s rank correlation coefficient was performed in all other cases. The differences were considered statistically significant at p <0.05.

Results. As a result of hospital treatment, clinical improvement was observed in the majority of children in both groups. More than half of the subjects regardless of the choice of the osmotic laxative developed regular bowel movements and soft stools during hospital stay. Adverse effects occurred in a small percentage of subjects.

Conclusions. The conducted study of efficacy and safety of lactulose and lactitol in children with chronic constipation confirmed similar efficacy and safety of these medications that allows recommending lactitol for widespread use in clinical practice.

Kazan medical journal. 2017;98(1):9-13
Assessment of gastric sleeve resection efficacy in treatment of patients with obesity
Omarov T.I., Mailova A.A.

Aim. To study the efficacy of longitudinal resection of the stomach in treatment of patients with obesity according to the results of two-year follow-up after the surgery.

Methods. During the period between 2012 and 2015 24 patients with obesity were operated on. In all of them longitudinal resection of the stomach was performed. The age of the patients was 21 to 63 years, mean body weight was 118.8±18.67 kg, mean body mass index (BMI) was 42.3±5.8 kg/m2. Before and after the surgery evaluation of excess weight, presence and characteristics of anemia (red blood cell count, concentration of hemoglobin, serum iron and vitamin B12) and quality of life according to Hamilton scale was performed.

Results. Weight loss during the first 2 years after the longitudinal resection of the stomach was 68% and it was less pronounced in patients with increased BMI. In patients with BMI <35 kg/m2 at the admission body weight was close to normal by the end of the first year after the surgery. In 4 patients with iron deficiency anemia after 2 years of follow-up hemoglobin concentration was 15.7% below its average preoperative level. 5 (20.8%) patients developed postoperative pernicious anemia. The average concentration of vitamin B12 in observed patients was 421.4±87.9 pmol/L before the surgery and 316.8±64.3 pmol/L after 2 years (p <0.001). Patients’ quality of life was noted to be improved after the performed surgery.

Conclusion. Longitudinal resection of the stomach is a very effective method of obesity treatment; it allows to achieve significant loss of excess body weight and to improve patients’ quality of life.

Kazan medical journal. 2017;98(1):14-17
Functional monitoring of patients with urolithiasis before and after extracorporeal lithotripsy
Sigal Z.M., Styazhkina S.N., Meshchanov S.Y., Sigal S.Z.

Aim. To determine the change of cardiovascular system parameters after extracorporeal lithotripsy.

Methods. The study involved 25 patients with urolithiasis from Urology Department of «The first Republican Clinical Hospital of Ministry of Healthcare of Udmurtia» in Izhevsk at the age of 25 to 45 years, of these, 10 females and 15 males. Lithotripsy was performed on all patients. Blood pressure, heart rate, stress index, blood oxygen saturation were measured before and after intervention.

Results. The data obtained allow us to conclude that in patients with urolithiasis after extracorporeal lithotripsy no specific changes in baseline cardiovascular system parameters occur. Systolic and diastolic blood pressure ranged between 5 to 10 mm Hg. Heart rate before and after extracorporeal lithotripsy practically did not change, blood oxygen saturation remained unchanged as well. Statistically significant reduction of stress index after extracorporeal lithotripsy was observed.

Conclusion. Functional monitoring of patients with urolithiasis after extracorporeal lithotripsy did not reveal any significant changes in blood pressure, heart rate, and blood oxygen saturation; stress index after the intervention statistically significantly decreased, but remains higher than normal.

Kazan medical journal. 2017;98(1):18-20
The state of immune system during the use of probiotic lactobacilli in complex treatment of papillomavirus infection
Borisov A.G., Savchenko A.A., Tihonova E.P., Sergeeva I.V., Kasparov E.V., Kudrjavcev I.V., Arutjunjan S.S.

Aim. Assessment of impact of probiotic lactobacilli complex on treatment efficiency and normalization of immune status in women with human papillomavirus infection (PVI).

Methods. Total of 65 patients of reproductive age with cervical pathology and PVI were examined. «Provag» was included into the standard therapy as the source of probiotic lactobacilli complex. Immunological studies were conducted before and after the treatment. The phenotypic profile of peripheral blood lymphocytes was determined by means of flow cytometry. The concentration of immunoglobulin A, G and M in serum was determined by ELISA.

Results. Decreased amounts of T- and NK-cells were observed in PVI patients on day 1. Regardless of treatment method, by day 30 the number of T-lymphocytes in the blood of women with PVI increases. Percentage of NK-cells remained below the normal values on day 30 in the group of patients who received traditional scheme of PVI treatment. Patients with PVI taking additionally probiotic lactobacilli complex showed an increase of NK-cells by the end of the treatment. On day 1 decrease of relative and absolute numbers of T-helper cells was detected. Regardless of the method of treatment by day 30 the number of T-helper cells increases to the reference level. IgM and IgG levels in peripheral blood of women with PVI were increased even on day 1. By the end of the observation period their concentration in patients with conventional treatment scheme remained increased. Patients receiving the standard therapy supplemented with «Provag» demonstrated the decrease of these classes of immunoglobulins to the reference level.

Conclusion. As a result of treatment normalization of NK-cells and T-helpers numbers was observed whereas the IgG and IgM levels remained increased.

Kazan medical journal. 2017;98(1):20-26
Pathogenetic features of the macrotypes of chronic endometritis
Radzinskiy V.E., Petrov Y.A., Kalinina E.A., Shirokova D.V., Polina M.L.

Aim. To expand the understanding of the pathogenesis of chronic endometritis based on the study of reception and markers of cell proliferation/apoptosis in its various macrotypes depending on the nature of microbial colonization.

Methods. We prospectively examined a group of 345 women with early reproductive losses (history of missed miscarriage, spontaneous abortion, artificial abortion, in vitro fertilisation failures during up to 6 months after intrauterine intervention), who had histologically verified chronic endometritis. A microbiological study of cervical discharge, aspirate from the uterus, identification of the pathogens with PCR, hysteroscopic and pathomorphological study of the endometrium (paypel biopsy) were performed. Identification of hysteroscopic hyperplastic, hypoplastic and mixed macrotypes was carried out on the basis of groups of features characterizing the thickness, color and the structure of the mucous membrane, intensity of vascular pattern in the presence of chronic inflammatory process. Immunohistochemistry of endometrium was performed to determine endometrial receptors for estrogen, progesterone («Dako», Denmark), proliferative activity of endometrial epithelial cells; the intensity of the expression of Ki-67 marker, that marks the cell nucleus at G1-, G2- and S-phase of the mitotic cycle, was taken into account. Apoptosis activity in endometrial biopsies was evaluated on the basis of expression of CPP32 proteins.

Results. Structural and functional disintegration of the endometrium in chronic endometritis is presented as disorders of strictly determined submicroscopic features of the cellular elements of the glandular epithelium and stroma of the endometrium, however, each of the macrotypes has its own characteristic disturbances of homeostasis and homeokinesis of endometrial tissue.

Conclusions. Further study of the markers of signaling pathways regulating proliferative cascades at the endometrial level matched with endometrial response to the invasion of a pathogen and morphological transformations will allow optimizing the diagnosis and treatment of chronic endometritis and restoration of reproductive potential after reproductive losses.

Kazan medical journal. 2017;98(1):27-34
Magnetic resonance imaging in the diagnosis of nonpalpable breast cancer
Vatankha S.S., Saryev S.A.

Aim. To analyze sensitivity of magnetic resonance imaging (MRI) in the diagnosis of breast cancer when used after mammography and breast ultrasound.

Methods. The study included 70 patients with nonpalpable breast lesions who had changes of breast tissue found at previous studies (mammography and breast ultrasound). MRI was performed with the use of Siemens Magnetom Avanto with magnetic field 1.5 Tl.

Results. Most frequently nonpalpable lesions were diagnosed in 45 to 60-year old patients (60%), a little rarer - in 39 to 45-year old patients (22.9%), in patients at the age of 61 to 69 - in 10.0% (7 patients). 7.1% patients were over 70. All first detected nonpalpable lesions of breast were biopsied for morphological verification. With the combined use of mammography, sonography, MRI and stereotactic biopsy the diagnosis was made in 100% patients. MRI with contract enhancement showed no relation between sensitivity, specificity and reliability and density of breast tissues.

Conclusions. MRI is considered a highly sensitive method of diagnosis and identification of changes found at mammography and breast ultrasound.

Kazan medical journal. 2017;98(1):34-37
Post-surgical heart rate variability in patients with brain tumor and epileptic seizures
Miranda A.A., Zhadnov V.A., Magerramov A.A.

Aim. To identify post-surgical perculiarities of heart rate variability in patients with brain tumors and symptomatic epilepsy.

Methods. The study group consisted of 85 patients (43 males and 42 females) aged 22 to 83 years admitted to neurosurgical department of Ryazan regional clinical hospital with brain tumor. The control group consisted of 20 relatively healthy individuals. The study group was divided into 2 subgroups of patients with brain tumor associated with symptomatic epilepsy and brain tumors without epileptic seizures. Five-minute ECGs in 3 functional probes (baseline, hyperventilation and post-hyperventilation) before and after craniotomy with tumor resection were recorded. The following statistical analysis of time and frequency parameters of heart rate variability was performed.

Results. Statistically significant differences in heart rate variability in pre- and post-surgical periods were found only in patients with epilepsy syndrome caused by brain tumor: mode increased by 11% in baseline and post-hyperventilation probes. Coefficient of variation and standard deviation were decreased by 29% in hyperventilation probe, index of centralization decreased by 60% in baseline probe and by 42% in post-hyperventilation probe. Statistically significant increase of high frequency power component by 46% was registered after surgical intervention in baseline probe and by 10% in post-hyperventilation probe. As opposed to this in the subgroup of patients with brain tumors and without epilepsy this parameter decresed by 10% in baseline probe.

Conclusion. The obtained results demonstrate significant post-surgical improvement of autonomic nervous system homeostasis and restoration of cardiovascular functional reserves in patients with brain tumor associated with epilepsy compared to those with no epileptic seizures.

Kazan medical journal. 2017;98(1):38-44
Some health aspects of children born with different types of intrauterine growth restriction during the early neonatal period
Derevtsov V.V.

Aim. To evaluate some health aspects of children born with different types of intrauterine growth restriction during the early neonatal period.

Methods. Clinical and anamnestic, physical, laboratory, electrophysiological, ultrasound and statistical methods were used. Children’s past medical history, development during early neonatal period, physical development, functioning of autonomic nervous system and cardiovascular system were assessed.

Results. It was revealed that development of different types of intrauterine growth restriction is related to father and mother’s age at the time of pregnancy, women’s body mass before pregnancy, and time of pregnancy complication development (abortion risk, pre-eclampsia, arterial hypertension, Rh-immunization, edema). Fetuses with asymmetric type of intrauterine growth retardation had survived hypoxia more often (by 4.87 times). Children with symmetrical type of intrauterine growth retardation were more often born by C-section (by 2.66 times), with smaller anthropometric measurements, with more frequent and severe hypotrophy, moderate and severe cerebral ischemia and mild intracranial hemorrhage, cryptorchidism, kidney diseases, atrial septal defects, muscular ventricular septal defects, open arterial duct, and depleted reserves. Children with asymmetric type of intrauterine growth retardation more often had hypoglycemia, jaundice, polycythemia, restricted adaptation reserves, myocardial metabolic disorders, anterior mitral valve leaflet prolapse, posthypoxic changes similar to hypertrophic cardiopathy.

Conclusion. Revealed features of past medical history, development during early neonatal period of life, physical development, functioning of autonomic nervous system and cardiovascular system in different types of children’s intrauterine growth restriction can promote formulation of criteria for early diagnosis of adaptive and reserve disorders and identification of dispensary groups.

Kazan medical journal. 2017;98(1):44-52
Features of inflammatory and regenerative reaction to excimer laser refractive keratectomy with photoprotection
Kornilovskiy I.M., Kasimov E.M., Sultanova A.I.

Aim. To study the features of inflammatory and regenerative reaction to excimer laser refractive keratectomy with photoprotection.

Methods. Clinical cases of 560 excimer laser refractive keratectomies with photoprotection in 280 patients with myopia and myopic astigmatism of different severity. The observation period varied from 1 month to 2.5 years.

Results. The study showed that intensity of aseptic inflammation and the type of regenerative response are influenced by the amount of evaporated corneal tissue, which correlates with the severity of myopia. Moreover, in case of equal severity of myopia and amount of evaporated tissue inflammatory and regenerative response was less prominent if excimer laser ablation was performed under the superficial corneal flap. In this case epithelial stromal corneal flap allowed reducing the negative effect of ultraviolet exposure and interaction between proinflammatory epithelial and stromal cytokines. At photorefractive ablation of corneal stroma saturated with 0.25% isotonic riboflavin solution aseptic inflammatory and regenerative response, intensity and duration of corneal syndrome decreased. Due to such technique of photorefractive keratectomy stromal layers saturated with riboflavin absorbed the secondary ultraviolet induced by ablation. Clinical observation demonstrated the need for additional photoprotection by glasses from external unltraviolet in all types of photorefractive surgeries on cornea up to full recovery of visual and optometric parameters. Use of photoprotection during excimer laser refractive ablation allowed achieving early stabilization of vision and refraction, decreasing the duration of postoperative steroidal and nonsteroidal anti-inflammatory drugs intake by one third in average.

Conclusion. Local photoprotection with riboflavin during excimer laser refractive keratectomy and photoprotection by glasses from external ultraviolet reduce the risk of oxidative stress in the cornea, postoperative aseptic inflammatory and regenerative reactions, promote stabilization of visual, optic refractive parameters and improve their predictability.

Kazan medical journal. 2017;98(1):53-57
Treatment of patients with chronic liver failure according to disease etiology
Kutepov D.E., Pasechnik I.N.

Aim. Improving the efficiency of treatment of patients with chronic liver failure by optimizing the application of extracorporeal detoxification methods.

Methods. The study included 292 patients with chronic liver failure (188 males and 104 females). The main causes of chronic liver failure were nutritional factor (alcohol abuse), viral liver diseases, and the combination of alcoholic and viral factors. All patients regardless of the disease etiology were divided into groups. Patients in group 1 received standard conservative therapy, aimed at relieving the symptoms of chronic liver failure. Patients in group 2 were additionally administered plasma exchange, in group 3 - PE and high-volume venovenous hemofiltration, and in group 4 - sessions of molecular adsorbent recirculating system (MARS).

Results. Mortality of patients with chronic liver failure on conservative treatment accounted for 84.0% and was 1.5-2.1 times higher than in other groups (53% in plasma exchange group, 52% when using plasma exchange and high-volume venovenous hemofiltration and 40.6% in MARS group), these differences being statistically significant when compared with group 1 (χ2 from of 18.3 to 23.4, p <0.05). Indicators, reflecting the time of 50% mortality of patients with chronic liver failure of different etiology, suggest that in chronic liver failure of alcoholic origin plasma exchange and a combination of plasma exchange and high-volume venovenous hemofiltration are the most effective, and in chronic liver failure of viral and mixed etiology the best results are obtained when using MARS.

Conclusion. The effectiveness of treatment of patients with chronic liver failure depends on the etiology of the disease: in alcoholic chronic liver failure plasma exchange and a combination of plasma exchange and high-volume venovenous hemofiltration are most rational, and in chronic liver failure of viral and mixed etiology MARS sessions are rational.

Kazan medical journal. 2017;98(1):58-63
Genetic predictors of cardiovascular system adaptation in adolescents to physical stress
Yarysheva V.B., Shibkova D.Z.

Aim. Analysis of genetic markers of physical performance and their interrelation with electrocardiographic parameters in athletes of the youth league.

Methods. The study involved 204 of adolescent athletes. EKGs were performed, the profile of genes of folate cycle and genes encoding the function of angiotensin-converting enzyme was detected by polymerase chain reaction in venous blood.

Results. It was found that all participants had sinus rhythm. Arrhythmias and conduction disorders were revealed: bradycardia was observed in 22 (10.7%) of participants, normocardia - in 168 (82%) participants, tachycardia - in 14 (6.8%) participants, incomplete right and left bundle branch block - in 16 (7.7%) participants, and repolarization disorders of left ventricle - in 5 (2.4%) young athletes. The genes polymorphism of folate cycle and genes encoding the function of angiotensin-converting enzyme in the examined individuals were presented in different variants. Majority of the participants had heterozygous forms in most genes except for the gene NOS3 894 G>T presented as a dominant form.

Conclusion. Accordng to EKG the athletes of the youth league had early repolarization of the left ventricle (2.4% cases), incomplete right or left bundle branch block (7.7% cases), and normal waves and intervals; according to genetic study most participants had heterozygous genotype GNB3 825 C>T, NOS3-786 T>C, AGT 704 T>C, negative correlation of QTc with NOS3-786 T>C and NOS3 894 G>T, α-angle / AGT 704 T>C with P-wave / NOS3 894 G>T.

Kazan medical journal. 2017;98(1):63-66
Time frames and volume of surgical intervention of reconstructive restorative stage after Hartmann’s procedure
Gataullin I.G., Khalikov M.M., Kozlova E.V., Afanas’eva Z.A., Potanin V.P.

Aim. To improve immediate and remote results of reconstructive restorative procedures in patients with complicated colorectal cancer.

Methods. The study is based on clinical experience of treatment of 107 patients who had reconstructive restorative procedures performed in specialized oncology institution after previous Hartmann’s procedure performed in urgent surgical department for complicated colorectal cancer. Reconstructive restorative procedures were performed at different time after the primary operation. To assess functional state of anal sphincter all patients were adminestered sphincteromentry during the preoperative period. Morphological analysis of all tissues removed during the surgery was performed. To evaluate morphological changes of distal end of the stump at different time a histological analysis was performed.

Results. According to the results of sphincterometry dynamic reduction of tonic contraction and maximum pressure of anal sphincter is observed. The more the period between Hartmann’s operation and reconstructive restorative surgery, the less pronounced muscle tone of anal sphincter. Histological studies of intestinal wall during the first 3 months after Hartmann’s surgery revealed intact quantity and size of intestinal crypts, non-significant inflammatory infiltration of mucous and submucous layers, during the period of 4 to 6 months - initial signs of diversion colitis, during the period of 7 to 12 months - atrophic changes in mucous membrane (reduction of crypts quantity, their shortening, decreased thickness of mucus), after 1 year - signs of atrophy of its submucous layer.

Conclusion. Reconstructive surgery in patients with previous Hartmann’s surgery for complicated colorectal cancer should be performed in specialized departments with all modern methods of surgical, radiation and medical treatment of colon cancer available; based on functional and morphological studies the optimal time frame for reconstructive surgery is 1 to 3 months after the initial surgery.

Kazan medical journal. 2017;98(1):67-72
Experimental medicine
Histologic evaluation of pathologic changes in gastrocnemius muscle in the model of rodent hindlimb ischemia
Titova A.A., Mavlikeev M.O., Pevnev G.O., Bilyalov A.I., Abyzova M.S., Latyshev A.A., Sakhapov D.I., Shafigullina A.K., Deev R.V., Kiyasov A.P.

Aim. Development of a model of hindlimb ischemia in rats to assess the effectiveness of gene and cell therapy.

Methods. In the first stage of this approach the external iliac artery was ligated immediately after bifurcation of the common iliac artery. Then the femoral artery was ligated before its branching into the descending genicular, popliteal and saphenous arteries with following dissection of arteries between ligatures. The second stage of this approach was performed seven days after the completion of the first stage: branches of popliteal artery to gastrocnemius muscle and formed collaterals were ligated and dissected. Hindlimb blood flow was assessed by laser Doppler flowmetry. Animals were euthanazied 14, 17, 21, 28, 35, 42 days after the first stage. The paraffin sections of gastrocnemius muscles were stained with Mallory trichrome and with antibodies to CD34.

Results. Histopathological analysis showed a continuous hindlimb ischemia of operated limb without any native skeletal muscle structure restoration and with significant interstitial fibrosis (11.89±5.53% vs 2.55±2.13% in intact limb by day 42, p <0.05). Polymorphic muscle fibers in operated limb with significantly smaller diameter and reduced capillary density (0.82±0.03 vs 1.91±0.06 in intact limb by day 42, p <0.05) were revealed. Laser Doppler flowmetry revealed reduction of blood flow in the operated limb (0.67±0.22 of intact limb blood flow by day 42).

Conclusion. Our developed two-stage model of hindlimb ischemia in rats leads to histologic changes characteristic for the same pathology in human.

Kazan medical journal. 2017;98(1):73-76
Thyroid diseases and risk of non-thyroidal pathology
Glushakov R.I., Kozyrko E.V., Sobolev I.V., Ermolova S.A., Vlaseva O.V., Kuzin A.A., Tapilskaya N.I.
The review presents generalized epidemiological data on the prevalence of non-neoplastic thyroid pathology in developed and developing countries, in particular in regions with iodine deficiency and the influence of mass iodine prophylaxis on reducing the incidence and prevalence of thyroid diseases in these regions. The data on the prevalence of subclinical hypo- and hyperthyroidism are presented, where according to the averaged data 1 clinical manifestation of thyroid insufficiency accounted for 20 cases of unregistered subclinical hypothyroidism, and 1 case of identified thyroid hyperfunction accounted for 15 cases of subclinical hyperthyroidism. Methodological, clinical and social difficulties in studying the prevalence of thyroid pathology are described. The main nongenomic actions of thyroid hormones, which originated from extracellular domains of cell adhesion protein - integrin αVβ3, resulting in activation of mitogen-activated protein kinase, phosphatidylinositol-3 kinase and serine-threonine-protein kinases, are presented. The ultimate cell and tissue response to this stimulation is the activation of cell proliferation, angiogenesis, cell migration, and increased expression of tissue-specific proinflammatory genes, which ultimately lead to acceleration of the «cancer development and its natural history». Data from epidemiological studies, which established a correlation between thyroid status and incidence (prevalence) of malignant neoplasms, are given. As a result of population-based studies analysis it was demonstrated that long term hyperthyroidism increases the risk of developing malignant neoplasms of different localizations, in particular breast, ovarian, prostate and lung cancer.
Kazan medical journal. 2017;98(1):77-84
Cardiovascular risk and history of gestational hypertension in women of reproductive age
Shamkina A.R., Sadykova A.R.
In recent years, gestational hypertension, defined in accordance with the classification of the European Society of Cardiology (2011) as hypertension induced by pregnancy, occurring with or without proteinuria, developing after 20 weeks of pregnancy and resolving up to 42 days after delivery, is considered as a adverse prognostic factor in respect of development of cardiovascular diseases in the future and cardiovascular mortality. This review presents the results of various studies on the relationship of history of gestational hypertension with risk factors for cardiovascular disease, target organ damage, associated clinical conditions and cardiovascular risk in women, including those of reproductive age. Determination of the individual cardiovascular risk in women, especially in young women, is difficult due to the low sensitivity and specificity of the tests in this category of patients. In spite of the conducted studies and obtained experience regarding issues on the relationship of history of hypertension during pregnancy with cardiovascular risk, until now the origin and the contribution of the various forms of hypertensive disorders during pregnancy, including gestational hypertension, to the development of future cardiovascular disease is still unclear. Detection of the history of gestational hypertension will allow to more accurately assess the individual cardiovascular risk and administer an adequate range of therapeutic and preventive measures for women, including those of reproductive age, at an earlier stage.
Kazan medical journal. 2017;98(1):85-91
Bisphosphonate-related osteonecrosis of the jaw: current state of the problem
Spevak E.M., Tsymbal A.N.
The article presents review of the literature on the current state of the problem of bisphosphonate-related osteonecrosis of the jaw. In Russia and abroad there are numerous reports of atypical lesions of the maxilla associated with taking medications on the basis of phosphorus or its analogues, in particular bisphosphonates. This is an issue: if earlier bisphosphonate treatment complications were limited to individual clinical observations, currently their frequency, according to different authors, reaches 8-27%. Bisphosphonate-related osteonecrosis of the jaw is characterized by unique etiopathogenic, clinical and diagnostic features that distinguish it from other inflammatory, degenerative and iatrogenic diseases of orofacial region, so it is reasonable to isolate it into an independent nosology, requiring a comprehensive study. According to current data, bisphosphonate-related osteonecrosis of the jaw is a complication of antiresorptive therapy, characterized by necrosis and exposure of bone area, which persists for more than 8 weeks, followed by the process progression in the absence of radiation therapy to the head area in history. Bisphosphonates are antiresorptive agents, potent inhibitors of bone tissue destruction, widely used for the treatment of bone metastasis, multiple myeloma, and hypercalcemia in cancer patients. However, the development of complications such as osteonecrosis of the jaw greatly reduces the positive effects of treatment, and extremely bothersome for patients. Osteonecrosis-related pyo-inflammatory processes of admaxillary tissue, the appearance of persistent sinus tracts on the skin and in the mouth, the risk of pathologic fracture of the jaw impair the quality of life of patients. Presented in the article analysis of currently known data about the bisphosphonate-related osteonecrosis of the jaw should attract the attention of dental surgeons, maxillofacial surgeons, endocrinologists, oncologists to this problem.
Kazan medical journal. 2017;98(1):91-95
Assessment of limbic system in cardiac patients during comprehensive rehabilitation
Yashukov V.V.
The article presents a review of domestic and foreign literature, containing basic information on the possibilities of assessing changes in the status of limbic system in cardiac patients in the process of comprehensive rehabilitation. The issues of a possible relationship between the limbic system structures and the cardiovascular system are considered. The key pathogenic mechanisms of mutual influence of the autonomic nervous system, limbic and cardiovascular systems at each other are described. The main aspects of the limbic system involvement in the regulation of mental and emotional state of a person are considered. The possibility of using different methods of study of changes in the limbic system status in cardiac patients in clinical practice was consistently assessed. Two main groups of methods: conventional test systems, as well as additional instrumental methods of examination of cardiac patients are investigated. The capacity of each of the methods, their advantages and limitations of use in clinical practice were compared. Particular attention is paid to the issue of assessment of anxiety and depression level. Cardiovascular tests are briefly described. Noteworthy fact is that currently there is no consensus on diagnostic tools to assess the changes in the status of the limbic system. The review describes a possible comprehensive diagnostic program. It is emphasized that it will be possible to optimize the comprehensive rehabilitation program of cardiac patients based on the obtained study results of the changes in the limbic system status.
Kazan medical journal. 2017;98(1):95-99
Social hygiene and healthcare management
Assessment of the state of medical scientific personnel of Russian Federation
Shljafer S.I.

Aim. To analyze the situation with scientific personnel and its training in the field of medical sciences in Russian Federation for 1995-2014 years.

Methods. Statistical and analytical methods were used. This study presents the analysis of data on personnel capacity and training of postgraduate students and doctoral students in the field of medical sciences in Russia during the period from 1995 to 2014 with the use of informational and statistical resources.

Results. In Russian Federation during the period of 1995-2014 we revealed decreasing number of researchers with PhD (by 3.25%), increasing number of doctors of medical sciences (by 44.8%) and significantly decreased number of researchers without scientific degrees (by 29.6%). The ratio of people with scientific degree in the field of medical sciences is higher than in other fields of sciences (69.2 vs. 29.3%). The process of aging of scientific personnel is continually observed. The average age of researchers increased from 45 to 47 years, PhD researchers - from 49.0 to 51.2 years, doctors of sciences - from 58.0 to 63.3 years and it is higher than the average age of employed in the economy of Russia (40.4 years). 26.0% of researchers are over 60 years. The biggest outflow from sciences is observed among efficient and promising specialists at the age of 40 to 49. In the field of medical sciences the most efficient training of highly skilled personnel can be noted. Almost one in three postgraduates (31.3%) and doctoral students (27.0%) presents the results of their thesis for defending that is higher than in other fields of science (18.35 vs. 17.0%, respectively).

Conclusion. Decreasing number of researchers was revealed; the process of aging of scientific personnel is continually observed; almost every third postgraduate and doctoral student presents the results of their thesis for defending that is higher than in other fields of science.

Kazan medical journal. 2017;98(1):100-104
Main trends of changes in indicators of emergency outpatient care for adult population of the large industrial city
Iskandarov I.R., Gilmanov A.A.

Aim. To study major trends of emergency outpatient visits on the example of the city of Naberezhnye Chelny adult population of different categories by age and sex according to the time indices - the month and day of the week.

Methods. 3,393,351 outpatient visits of the Naberezhnye Chelny adult population for 2011-2013 were analyzed.

Results. The highest attendance rates of adult population to health organizations providing emergency care in outpatient settings were registered in spring (March, April, May) and in autumn (September, October, November) with a peak attendance in April and October. There is a certain pattern of distribution of cases of outpatient visits for acute exacerbation of chronic diseases, and by the day of the week. Thus, a significant number of patients attended health organizations on Monday (26%). In the following days, their number gradually decreased and reached minimum on Saturday and Sunday. During the study period, the number of outpatient visits for acute exacerbation of chronic diseases by adult population on Monday rose by 12.1%. In the structure of emergency outpatient care, proportion of the diseases of respiratory, musculoskeletal and circulatory systems was the highest. During the study period number of visits for diseases of respiratory system increased by 2.4%, circulatory system - by 1.2%, musculoskeletal system - has not changed.

Conclusion. The main workload of medical organizations providing emergency care in outpatient settings is unequally distributed by days of the week and months; there is a need for translating outpatient care on a 7-day work schedule to avoid the maximum load on the outpatient clinic on Monday and in the morning hours as a result of the accumulated over the weekend and night hours incidence.

Kazan medical journal. 2017;98(1):105-110
Sanitary evaluation of working environmental physical and chemical factors of passenger car attendants in Mongolia
Erkegul S., Tarmaeva I.Y., Savchenkov M.F.

Aim. To perform sanitary assessment of physical and chemical factors of the working environment of passenger car attendants in Mongolia.

Methods. The study for evaluation of working conditions was performed at attendants’ workplace in 36 passenger car manufactured in 1982-1999 in Russia and Germany and used for passenger transportation by Mongolian railway. Sanitary studies of physical and chemical factors of the working environment of passenger car attendants were conducted. Total of 1430 studies were performed.

Results. The results of sanitary evaluation of working conditions of Mongolian passenger car attendants indicate that air temperature, relative humidity, air flow, illumination, noise and vibration levels, dust content, carbon monoxide concentration, and diesel fuel products in some cases do not meet the sanitary requirements. Prolonged exposure to the combination of these factors can lead to organic disorders.

Conclusion. The working environment of Mongolian passenger car attendants is characterized by complex influence of unfavorable factors such as rapid changes of temperature during the shift, high levels of whole body vibration, dust, and presence of harmful chemicals in the air of the working area. Exposure to adverse factors of the working environment and work activities of passenger car attendants of Mongolian railway may cause harm to their health.

Kazan medical journal. 2017;98(1):111-115
Hygienic assessment of pesticides and chemical fertilizers use in agriculture of the Republic of Tatarstan
Khamitova R.Y., Sabirzyanov A.R., Ziatdinov V.B.
AIM. Hygienic assessment of pesticides and chemical fertilizers use on the background of other technogenic environmental chemical components influence and determination of their contribution to non-infectious morbidity of adult population. METHODS. The analysis included parameters of chemical technogenic impact on air, water bodies, and soil including those reflecting impact of use of pesticides and chemical fertilizers and resource-saving soil tillage technologies. The connection between parameters characterizing use of pesticides and primary and total morbidity and prevalence of endocrine, cardiovascular, and respiratory diseases of the adult population of the Republic of Tatarstan in 2000-2014 was analyzed. RESULTS. During the analyzed period quantitative and qualitative characteristics of pesticides use have changed dramatically in the republic: the area of soil tillage and gross volume of pesticides, primarily, herbicides, stocks and range of products have increased. Over 15 years in the republic the area of soil tillage has increased by 2.3 times, consumption of pesticides - by 1.9 times, and herbicides - by 2.85 times. Due to active implementation of resource-saving technologies into agriculture the ratio and volume of glyphosate herbicides use have increased. Among the adult population the incidence of cancer and prevalence of cardiovascular and endocrine diseases have increased. The incidence of cancer increased by 25.7% among people of working age and even more (by 39.1%, p <0.01) among elder people. The areas of resource-saving soil tillage technologies and the volume of glyphosate herbicides correlated with primary and overall cancer incidence and prevalence of endocrine diseases. 32.5 to 100% of direct significant contribution of technogenic chemical influence on environment objects to prevalence of known disease classes is associated with pesticides and chemical fertilizers use. CONCLUSION. Due to high population density (55.6 people/sq.km), development of oil, mechanical and other industries and agricultural sector, accompanied by increase of chemical impact on air, hydrosphere and lithosphere, the further expansion of the area of minimal and zero tillage technology, occupying nowadays half of the republic territory, should be performed with great caution and constant laboratory and epidemiologic monitoring.
Kazan medical journal. 2017;98(1):116-121
Hemophilia prevalence in Azerbaijan
Kazimova M.M., Kadimova E.A.

Aim. Assessment of hemophilia prevalence in Azerbaijan.

Methods. Materials of the study were the data of the registry on hemophilia. Prevalence and its structure were calculated for the regions and towns of republican subordination: the number of hemophilia patients with all types were calculated per 100 000 people. We determined the following groups: 0-4, 5-13, 14-18, 19-44, 45 years and older. According to clinical forms of the pathology we differentiated hemophilia А, hemophilia В, Willebrand’s disease and other forms. According to severity the patients were divided into 3 groups: severe with factors VIII and IX activity less than 1%, moderate - 2-5%, and mild - 5% and higher.

Results. Hemophilia prevalence in Azerbaijan Republic is 17.2±0.44 per 100 000 people. Baku is leading, where it is 33.1±1.22 hemophilia cases per 100 000 people. Relatively high prevalence rate was recorded in Sumgait city (22.8±2.61 per 100 000 people). Among hemophilia patients a male predominance is observed (1323 people, 87.2% of all patients). In all age groups hemophilia A is predominant and ratios of hemophilia B, Willebrand’s disease and other forms are significantly lower. Mild form of hemophilia was registered most often. Proportion of patients with severe hemophilia was lowest in the group with Willebrand’s disease (13%) and highest in the group with other hemophilia types (46.6%).

Conclusion. Hemophilia prevalence in Azerbaijan is high (17.2±0.44 per 100 000 people) and regional and age distribution differences are clearly pronounced; in nosological structure hemophilia A and other forms are predominant, nevertheless every fifth patients has severe form of the pathology.

Kazan medical journal. 2017;98(1):122-124
Prevalence and risk factors of glaucoma among the population of Ganja city, Azerbaijan
Agaeva K.F., Mamedova N.O., Nabiev T.F.

Aim. To determine prevalence of glaucoma among adult urban population on example of Ganja city of the Azerbaijan Republic.

Methods. In city polyclinics primary examination was performed in 6585 people that makes 3% of adults of the population. Among the examined patients the indications for thorough in-patient work-up were determined in 250 patients. The diagnosis of glaucoma was confirmed in 220 patients (90 males and 130 females). The prevalence of glaucoma was determined (in % of the examined patients). The patients were divided into groups according to their gender, age, education, family history, presence of eye and internal diseases. A group with the lowest prevalence of glaucoma was chosen as a reference, and the other groups were termed as study groups for the assessment of relative risk of glaucoma development.

Results. Glaucoma was revealed in 2.7±0.28% of males and 3.9±0.34% of females (p <0.05). Morbidity rate in women is higher compared to men. Risk factors of glaucoma are: intraocular pressure >21 mm Hg - 3.8±0.24%, compromised family history - 4.7±0.27%, diabetes mellitus - 3.66±0.24%, myopia - 5.7±0.3%, cataract - 10.0±0.4%, arterial hypertension - 11.9±0.4%. General morbidity rate of glaucoma among patients older than 20 years old is 3.45±0.23%. The lowest prevalence of glaucoma was determined among people of 20-29 years old (0.9±0.22%; 95% confidence interval 0.40-1.33). Prevalence of glaucoma increases with age of the examined patients. Statistically significant increase of prevalence of glaucoma is detected among population aged 40 years or older (3.3±0.49% of people aged 40-49 years) and reaches its maximum among people aged 60-69 years (12.2±1.56%).

Conclusion. Prevalence of glaucoma among population of Ganja aged 20 years and older is comparatively high; differentiated monitoring of intraocular pressure with risk factors taken into account is reliable for early detection of glaucoma.

Kazan medical journal. 2017;98(1):125-128
Clinical observations
A clinical case of renal tubular acidosis type 1 in a 1-month old baby
Voljanjuk E.V., Lutfullin I.J.
Renal tubular acidosis is a group of tubular diseases of the kidneys, whiсh are characterized by disorders of bicarbonate reabsorption, secretion of hydrogen ions, or a combination of both defects and cause metabolic acidosis with preserved glomerular filtration. Distal renal tubular acidosis is characterized by severe hyperchloraemic metabolic acidosis due to impaired excretion of hydrogen ions in the distal nephron. The prevalence of the primary distal renal acidosis is 1:40 000. Most often the first onset of the disease occurs at the age of 6 months to 2 years. The article presents a rare case of tubular acidosis type 1 in a child at the age of 1 month and 5 days. The presented case demonstrates that renal tubular acidosis can clinically manifest in children during the first months of life leading even at this age to severe metabolic disorders requiring certain raised level of suspicion for this pathology. Rarity of distant tubular acidosis is one of the factors predisposing to difficulty and tardiness of its diagnosis that leads to early disability and high risk of life-threatening conditions.
Kazan medical journal. 2017;98(1):129-131
Clinical experiences
Algorithm to identify the signs of threatened preterm labour
Akhmetgaliev A.R., Fatkullin I.F., Munavirova A.A., Fatkullin F.I.

Aim. To develop the algorithm of identification the signs of threatened preterm labour based on statistical and clinical comparison of modern available diagnostic tests: ultrasound cervicometry and express test-systems for measuring placental α1-microglobulin in cervical secretion.

Methods. The analysis of case histories of patients with a diagnosis of «threatened preterm labor» was performed.

Results. Total of 12 patients had premature labour accounting for 14.12%. In 8 of them placental α1-microglobulin in cervical secretion was positive and only in 5 patients cervical length was ≤20 mm according to ultrasound cervicometry. 4 patients with premature birth (ranging from 48 hours to 7 days) had false-negative test results. 7 (8.2%) patients had a false-positive result of placental α1-microglobulin test, and these patients subsequently had term birth. The sensitivity of the test for placental α1-microglobulin as a marker of premature birth was 66.67%, specificity 95.9%, specificity of ultrasound cervicometry - 47.9%, and sensitivity - 41.7%. Use of the combination of both tests can significantly reduce hyperdiagnosis of threatened preterm labour.

Conclusion. Females with short cervix according to ultrasound cervicometry should reasonably be tested for placental α1-microglobulin in cervical discharge; positive result of this test will be found in those whose probability to give preterm labour during the next 14 days reaches 72.72%, and high prognostic value of a negative test result allows observing the patients in outpatient setting.

Kazan medical journal. 2017;98(1):132-136
Significance of ipsilateral lobar lymph node dissection in the surgical treatment of non-small cell lung cancer with regional lymph node involvement
Gil’metdinov A.F., Potanin V.P.

Aim. Analysis of significance of ipsilateral lobar lymph node dissection in the surgical treatment of non-small cell lung cancer with regional lymph node involvement.

Methods. We have analyzed medical records of inpatients and outpatients observed in Republican Clinical Oncology Dispensary of Tatarstan Ministry of Healthcare and operated in 2000-2009. Patients were divided into the groups according to the stage (IB, IIB, IIIA), clinical and anatomic form (peripheral or central cancer), volume of surgery (lobectomy and pulmonectomy) and degree of primary tumor spread and lymph node involvement according to TxNx (T2N0, T2N1, T3N0, T2N2). Total of 803 patients were included. Five-year survival rate in each group was counted by the method of Kaplan-Meier based on volume of surgery (lobectomy and pulmonectomy) and lymph node status (N1, N2).

Results. In peripheral cancer with regional lymph nodes status N1-2 pulmonectomy with removal of ipsilateral lobar lymph nodes is associated with low survival. In central cancer regional lymph node status change from N0 to N1 does not influence survival after lobectomy/pulmonectomy indicating the positive effect of removal of ipsilateral lobar lymph nodes on survival in this group of patients. In central cancer with N2 survival after pulmonectomy decreases by 2 times indicating no influence of removal of ipsilateral lobar lymph nodes on survival in this group of patients.

Conclusion. In peripheral cancer with morphologic confirmation of regional lymph node involvement N1-2, as well as in central cancer with morphologic confirmation of regional lymph node involvement N2, ipsilateral lobar lymph node dissection is irrational; in all other cases (central cancer N0-1 or peripheral cancer N0) ipsilateral lobar lymph node dissection is rational.

Kazan medical journal. 2017;98(1):137-140
Immunochemiluminescence in the diagnosis of relapsing froms of echinococcosis
Kasyev N.B., Aytnazarov M.S., Kazieva A.A., Nurbekova A.N.

Aim. To improve immunologic diagnosis of relapsing and residual echinococcosis we used the novel chemiluminescent method based on registration of changes of biologic fluids emmision in normal and pathologic conditions.

Methods. We observed 136 patients with relapsing echinococcosis, 109 patients with primary echinococcosis and 91 patients with residual cavities after echinococcectomy. As a control we included 186 patients with other diseases such as hepatitis, liver cirrhosis, liver and lung cancer, cholecystitis and others having some clinical similarity with echinococcosis and requiring differential diagnosis, and also 30 donors were included. Besides, 111 people previously operated for echinococcosis (6 month to 10 years prior) were examined.

Results. In comparison of immunochemiluminescence with well-known serologic test this method demonstrated some benefits: short time to receiving the results, small amount of the blood necessary for the analysis (0.02 ml), high specificity and sensitivity. As the time period after the surgery increases, intensity of luminescence in immunochemiluminescence gradually decreases in case of no relapse and increases in relapse.

Conclusion. Immunochemiluminescence of the whole blood is a valuable diagnostic method; this method should be included to diagnostic workup for patients with suspected echinococcosis; immunochemiluminescence provides the opportunity to define pathology and radicality of performed surgery and to reveal the disease relapse.

Kazan medical journal. 2017;98(1):141-143
History of medicine
90th anniversary of the Department of Radiation Diagnostics of Kazan State Medical Academy of postdegree education
Mihaylov M.K.
The history of formation of the Department of radiation diagnostics in Kazan state medical academy is tightly connected with the history of roentgenology in Kazan. The Department of radiation diagnostics celebrates its 90th anniversary being deeply and successfully involved in training of highly-skilled specialists - radiation diagnosticians - and in research activities. In 1920 in Kazan the Institute for Doctor’s Improvement was organized (nowadays it is named Kazan state medical academy). The Board of the Institute decided to organize laboratories and X-ray unit on the basis of therapeutic clinic. The first study was conducted by the rector himself, professor A.R. Lurija. In 1927 assistant professor R.Ja. Gasul’, professor M.I. Nemenov’s apprentice, invited from Leningrad was elected as the Head of the Department. During the last few years professors E.F. Rottermel’, D.E. Gol’dshtejn, M.H. Fajzullin were Heads of the Department and since 1982 till present professor M.K. Mikhajlov has been the Head of the Department of radiation diagnostics.
Kazan medical journal. 2017;98(1):144-148
Development of prosthodontics in higher medical education of the Republic of Tatarstan
Abrosimova M.Y., Ivanov A.Y., Saleeva G.T., Kravchenko K.V.
The aim of this study was conducting historiographical analysis of organizational bases of formation and development of prosthodontics in the Republic of Tatarstan, as one of the core dental specialties, along with therapeutic and surgical dentistry. Historico-genetic and comparative research methods were used. The reflection of the history of the prosthodontics departments development in Kazan State Dental Institute, Kazan State Medical University, Kazan State Medical University in the literature and archival materials is presented. The main scientific achievements and contribution to the practical activities of the departments’ heads (I.M. Oksman, L.M. Demner, M.Z. Mirgazizov) and staff are demonstrated. The article proves that studying various issues of dental disciplines development is a very promising field of the modern history of science. This is due to the fact that in the modern world, dentistry is undergoing qualitative changes as a science and practice, which makes the study of the historical aspects of its development significantly more relevant. Analysis of the formation and development of prosthodontics in Kazan suggests that unlike some other centers of national dentistry development in Kazan it had a well-organized framework. Thus, organized in 1936 Kazan State Dental Institute and the Department of Prosthodontics have made a significant contribution to the development of higher medical education in Kazan, the development of dental science and practice.
Kazan medical journal. 2017;98(1):149-154
Professor Anas Anvarovich Gil’manov 60 years
Kazan medical journal. 2017;98(1):155-156
Professor Galib Shalon ogly Garaev 70 years
Kazan medical journal. 2017;98(1):157-158
Professor Eduard Salikhovich Valishin
Kazan medical journal. 2017;98(1):159-160

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